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Member Research and Reports

Columbia: A Perspective on Precision Public Health Published in NEJM

Researchers at Columbia Mailman School of Public Health critically examine the idea of “Precision Public Health” in a new paper in the New England Journal of Medicine. According to the authors, the “precision” term has been used in a non-precise manner up to now and requires a more conceptual analysis before the field goes forward.

The Precision Medicine Initiative, launched by President Obama, and promoted by National Institutes of Health (NIH) director Francis Collins, defined precision medicine as “prevention and treatment strategies that

take individual variability into account.” The trend toward precision medicine has now been extended to “precision public health.” For authors Dr. Merlin Chowkwanyun and Dr. Ronald Bayer this means changes to the mission of public health are now in the offing, with significant implications for approaches to population health.

“There are key issues to consider before public health aligns with the precision agenda, writes Dr. Chowkwanyun, Donald H. Gemson assistant professor of Sociomedical Sciences.

Public health begins at the population level, with social class, ethnic background, gender and sexual identity, and physical environment, playing a role in increased vulnerability — properties of one’s shared surroundings.  Therefore, the question for Drs. Chowkwanyun and Bayer is:  does this alignment represent an abandonment of our mission of enhancing population well-being?

“The struggle to navigate the tension between the macro and the granular has reached a fever pitch in the precision era,” notes Dr. Bayer, professor of sociomedical sciences. “However, first and foremost the conversation requires those in the field to clarify the divide between precision medicine and traditional public health analysis, policy, and practice.”

Dr. Sandro Galea is a co-author.

Read the NEJM paper